Provider Demographics
NPI:1063575397
Name:MANJOORAN, M.D., ELIZABETH D (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:D
Last Name:MANJOORAN, M.D.
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 E OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-2120
Mailing Address - Country:US
Mailing Address - Phone:847-375-0707
Mailing Address - Fax:847-375-0808
Practice Address - Street 1:1595 E OAKTON ST
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-2120
Practice Address - Country:US
Practice Address - Phone:847-375-0707
Practice Address - Fax:847-375-0808
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36087868208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36087868Medicaid
IL36087868Medicaid